Canagliflozin, a new sodium–glucose cotransporter 2 inhibitor, in the treatment of diabetes

Nisly, Sarah A.; Kolanczyk, Denise M.; Walton, Alison M.

doi:10.2146/ajhp110514

Cited by 35 publications

(32 citation statements)

References 20 publications

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“…85,87,88 Clinical studies focused on the efficacy of SGLT2 inhibitors have shown an average decrease in HbA1c of 0.5%-0.9%. [88][89][90][91] Adding SGLT2 inhibitors in patients receiving first-line monotherapy resulted in an increase proportion of subjects achieving a HbA1c <7%, with low risk of hypoglycaemic events. 90 In addition to glycaemic control, SGLT2 inhibitors cause a weight reduction of approximately 2 kg already at 6 weeks after initiation of therapy.…”

Section: Sglt-2 Inhibitorsmentioning

confidence: 99%

Safety and efficacy of antihyperglycaemic agents in diabetic kidney disease

Niezen

Castillo

Castaner

et al. 2019

Endocrino Diabet & Metabol

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Diabetic kidney disease (DKD) is the major contributor to the mortality and the financial burden of diabetes, accounting for approximately 50% of the cases of end‐stage renal disease (ESRD) in the developed world. Several studies have already demonstrated that achieving blood pressure targets in DKD with agents blocking the renin‐angiotensin system confer superior renoprotection when compared to other agents. However, the effects on renal outcomes of antihyperglycaemic agents in these patients have not been reported or studied broadly until recent years. The intent of this article is to review the available data on safety, efficacy, impact on renal outcomes and pathophysiology implications of the most utilized antihyperglycaemic agents in DKD/ESRD.

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Section: Sglt-2 Inhibitorsmentioning

confidence: 99%

Safety and efficacy of antihyperglycaemic agents in diabetic kidney disease

Niezen

Castillo

Castaner

et al. 2019

Endocrino Diabet & Metabol

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“…The mechanisms and efficacy of these agents have been reviewed elsewhere (129–131). The main advantage of SGLT-2 inhibitors is a completely different mechanism of action; they work primarily to lower the renal threshold to glucose, leading to increased glucose excretion and decreased plasma glucose levels.…”

Section: Safety Considerations For the Major Drug Classes For Type 2 mentioning

confidence: 99%

Beyond Metformin: Safety Considerations in the Decision-Making Process for Selecting a Second Medication for Type 2 Diabetes Management

et al. 2014

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The trend toward personalized management of diabetes has focused attention on the differences among available pharmacological agents in terms of mechanisms of action, efficacy, and, most important, safety. Clinicians must select from these features to develop individualized therapy regimens. In June 2013, a nine-member Diabetes Care Editors’ Expert Forum convened to review safety evidence for six major diabetes drug classes: insulin, sulfonylureas (SUs), thiazolidinediones (TZDs), glucagon-like peptide-1 receptor agonists, dipeptidyl peptidase-4 inhibitors, and sodium glucose cotransporter 2 inhibitors. This article, an outgrowth of the forum, summarizes well-delineated and theoretical safety concerns related to these drug classes, as well as the panelists’ opinions regarding their best use in patients with type 2 diabetes. All of the options appear to have reasonably wide safety margins when used appropriately. Those about which we know the most—metformin, SUs, insulin, and perhaps now also TZDs—are efficacious in most patients and can be placed into a basic initial algorithm. However, these agents leave some clinical needs unmet. Selecting next steps is a more formidable process involving newer agents that are understood less well and for which there are unresolved questions regarding risk versus benefit in certain populations. Choosing a specific agent is not as important as implementing some form of early intervention and advancing rapidly to some form of combination therapy as needed. When all options are relatively safe given the benefits they confer, therapeutic decision making must rely on a personalized approach, taking into account patients’ clinical circumstances, phenotype, pathophysiological defects, preferences, abilities, and costs.

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“…Use of selective SGLT2 inhibitors significantly lowers HbA1c levels by 0.5–1.5% without hypoglycemia [12–17]. Use of SGLT inhibitors also showed significant weight loss and reduction of systemic blood pressure [13, 14, 16–18]. Increased genital infection and possibly increased urinary tract infection were noticed but rarely caused drug discontinuation [7, 11, 16, 17, 19].…”

Section: Introductionmentioning

confidence: 99%

A Review on the Relationship between SGLT2 Inhibitors and Cancer

Lin

Tseng

2014

International Journal of Endocrinology

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Risk of increasing breast and bladder cancer remains a safety issue of SGLT2 (sodium glucose cotransporter type 2) inhibitors, a novel class of antidiabetic agent. We reviewed related papers published before January 29, 2014, through Pubmed search. Dapagliflozin and canagliflozin are the first two approved SGLT2 inhibitors for diabetes therapy. Although preclinical animal toxicology did not suggest a cancer risk of dapagliflozin and overall tumor did not increase, excess numbers of female breast cancer and male bladder cancer were noted in preclinical trials (without statistical significance). This concern of cancer risk hindered its approval by the US FDA in January, 2012. New clinical data suggested that the imbalance of bladder and breast cancer might be due to early diagnosis rather than a real increase of cancer incidence. No increased risk of overall bladder or breast cancer was noted for canagliflozin. Therefore, the imbalance observed with dapagliflozin treatment should not be considered as a class effect of SGLT2 inhibitors and the relationship with cancer for each specific SGLT2 inhibitor should be examined individually. Relationship between SGLT2 inhibition and cancer formation is still inconclusive and studies with larger sample size, longer exposure duration, and different ethnicities are warranted.

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Canagliflozin, a new sodium–glucose cotransporter 2 inhibitor, in the treatment of diabetes

Cited by 35 publications

References 20 publications

Safety and efficacy of antihyperglycaemic agents in diabetic kidney disease

Safety and efficacy of antihyperglycaemic agents in diabetic kidney disease

Beyond Metformin: Safety Considerations in the Decision-Making Process for Selecting a Second Medication for Type 2 Diabetes Management

A Review on the Relationship between SGLT2 Inhibitors and Cancer

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